Glasgow Prognostic Score informative in some with gastric cancer

Last Updated: 2016-03-04

By David Douglas

NEW YORK (Reuters Health) - The inflammation-based Glasgow Prognostic Score (GPS) points to outcome in patients undergoing gastric resection without any perioperative treatment, according to German researchers.

As Dr. Nathaniel Melling told Reuters Health by email, "We found GPS in gastric cancer to be associated with synchronous distant metastases, vessel infiltration, resection margin and perioperative mortality, which, to our knowledge, has not been reported on before. The latter has been shown to be linked to poor preoperative nutritional status in cancer patients and therefore should lead to a modified preparatory regime including substitution of nutrients and calories."

In a paper online February 18 in Surgery, Dr. Melling and colleagues at University Hospital Hamburg-Eppendorf note that the GPS relies on C-reactive protein (CRP), a key factor in the progression of some tumors and hypoalbuminemia that may be tied to poor survival in advanced cancers.

Patients with both elevated CRP and hypoalbuminemia are allocated a score of 2. Those with only one aberrant value have a score of 1. Those with neither are rated as 0.

To investigate the GPS prognostic utility, the team retrospectively examined data on 88 gastric cancer patients undergoing surgical treatment alone.

GPS was linked to aggressive tumor biology in terms of tumor size. For example, GPS 0 yielded 51.2% T1 and T2 and 48.8% T3 and T4. For GPS 1, the corresponding findings were 23.8% T1 and T2 and 76.2% T3 and T4. For GPS 2, they were 23.1% T1 and T2 and 76.9% T3 and T4.

There were similar relationships with synchronous distant metastases, venous vessel invasion and resection margin status.

Median overall survival was 16.2 months. In those with a GPS of 0, survival was 25.2 months compared to 15.3 months with GPS 1 and 5.8 months with GPS 2.

There were no perioperative deaths in the GPS 0 patients. However, perioperative mortality was 20% in G1 patients and 80% in the G2 group.

"Our results show that GPS is an independent prognosticator of survival in GC without perioperative treatment and that it is also strongly linked to perioperative mortality," Dr. Melling said. "GPS is simple to measure and widely available. Since our study design does not allow the results to be regarded as guidelines for therapeutic decisions, surgery should not be denied or tailored for patients with a high GPS."

"Nonetheless," he concluded, "GPS may well be suited for preoperative stratification of patients into groups of poor or favorable outcome. Preoperative evaluation of the GPS may help to stratify gastric cancer patients to different risk profiles, which is essential in the era of customized therapy. Due to this fact, our institution has gone over to routinely assessing CRP and albumin levels on preoperative admission for all cancer patients."

SOURCE: bit.ly/21KaEND

Surgery 2016.